Provider Demographics
NPI:1326776550
Name:KIM, LINDA MARY (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:MARY
Last Name:KIM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 PEBBLE BEACH PL
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-2727
Mailing Address - Country:US
Mailing Address - Phone:703-832-7837
Mailing Address - Fax:
Practice Address - Street 1:521 PEBBLE BEACH PL
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-2727
Practice Address - Country:US
Practice Address - Phone:703-832-7837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty